Multidisciplinary Collaboration in the Treatment of Patients With Type 2 Diabetes in Primary Care: Analysis Using Process Mining

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Abstract

Background

Public health in several countries is characterized by a shortage of professionals and a lack of economic resources. Monitoring and redesigning processes can foster the success of health care institutions, enabling them to provide a quality service while simultaneously reducing costs. Process mining, a discipline that extracts knowledge from information system data to analyze operational processes, affords an opportunity to understand health care processes.

Objective

Health care processes are highly flexible and multidisciplinary, and health care professionals are able to coordinate in a variety of different ways to treat a diagnosis. The aim of this work was to understand whether the ways in which professionals coordinate their work affect the clinical outcome of patients.

Methods

This paper proposes a method based on the use of process mining to identify patterns of collaboration between physician, nurse, and dietitian in the treatment of patients with type 2 diabetes mellitus and to compare these patterns with the clinical evolution of the patients within the context of primary care. Clustering is used as part of the preprocessing of data to manage the variability, and then process mining is used to identify patterns that may arise.

Results

The method is applied in three primary health care centers in Santiago, Chile. A total of seven collaboration patterns were identified, which differed primarily in terms of the number of disciplines present, the participation intensity of each discipline, and the referrals between disciplines. The pattern in which the three disciplines participated in the most equitable and comprehensive manner had a lower proportion of highly decompensated patients compared with those patterns in which the three disciplines participated in an unbalanced manner.

Conclusions

By discovering which collaboration patterns lead to improved outcomes, health care centers can promote the most successful patterns among their professionals so as to improve the treatment of patients. Process mining techniques are useful for discovering those collaborations patterns in flexible and unstructured health care processes.

Related collections

Most cited references 39

Record: found
Abstract: found
Article: not found

Patient adherence to treatment: three decades of research. A comprehensive review.

J P M Denekens, H Hearnshaw, E Vermeire … (2001)

Low compliance to prescribed medical interventions is an ever present and complex problem, especially for patients with a chronic illness. With increasing numbers of medications shown to do more good than harm when taken as prescibed, low compliance is a major problem in health care. Relevant studies were retrieved through comprehensive searches of different database systems to enable a thorough assessment of the major issues in compliance to prescribed medical interventions. The term compliance is the main term used in this review because the majority of papers reviewed used this term. Three decades have passed since the first workshop on compliance research. It is timely to pause and to reflect on the accumulated knowledge. The enormous amount of quantitative research undertaken is of variable methodological quality, with no gold standard for the measurement of compliance and it is often not clear which type of non-compliance is being studied. Many authors do not even feel the need to define adherence. Often absent in the research on compliance is the patient, although the concordance model points at the importance of the patient's agreement and harmony in the doctor-patient relationship. The backbone of the concordance model is the patient as a decision maker and a cornerstone is professional empathy. Recently, some qualitative research has identified important issues such as the quality of the doctor-patient relationship and patient health beliefs in this context. Because non-compliance remains a major health problem, more high quality studies are needed to assess these aspects and systematic reviews/meta-analyses are required to study the effects of compliance in enhancing the effects of interventions.

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Record: found
Abstract: not found
Article: not found

Tests of glycemia in diabetes.

D E Goldstein, R. Little, R. A. Lorenz … (2004)

0 comments Cited 145 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Geriatric care management for low-income seniors: a randomized controlled trial.

Steven Counsell, Christopher M Callahan, Daniel Clark … (2007)

Low-income seniors frequently have multiple chronic medical conditions for which they often fail to receive the recommended standard of care. To test the effectiveness of a geriatric care management model on improving the quality of care for low-income seniors in primary care. Controlled clinical trial of 951 adults 65 years or older with an annual income less than 200% of the federal poverty level, whose primary care physicians were randomized from January 2002 through August 2004 to participate in the intervention (474 patients) or usual care (477 patients) in community-based health centers. Patients received 2 years of home-based care management by a nurse practitioner and social worker who collaborated with the primary care physician and a geriatrics interdisciplinary team and were guided by 12 care protocols for common geriatric conditions. The Medical Outcomes 36-Item Short-Form (SF-36) scales and summary measures; instrumental and basic activities of daily living (ADLs); and emergency department (ED) visits not resulting in hospitalization and hospitalizations. Intention-to-treat analysis revealed significant improvements for intervention patients compared with usual care at 24 months in 4 of 8 SF-36 scales: general health (0.2 vs -2.3, P = .045), vitality (2.6 vs -2.6, P < .001), social functioning (3.0 vs -2.3, P = .008), and mental health (3.6 vs -0.3, P = .001); and in the Mental Component Summary (2.1 vs -0.3, P < .001). No group differences were found for ADLs or death. The cumulative 2-year ED visit rate per 1000 was lower in the intervention group (1445 [n = 474] vs 1748 [n = 477], P = .03) but hospital admission rates per 1000 were not significantly different between groups (700 [n = 474] vs 740 [n = 477], P = .66). In a predefined group at high risk of hospitalization (comprising 112 intervention and 114 usual-care patients), ED visit and hospital admission rates were lower for intervention patients in the second year (848 [n = 106] vs 1314 [n = 105]; P = .03 and 396 [n = 106] vs 705 [n = 105]; P = .03, respectively). Integrated and home-based geriatric care management resulted in improved quality of care and reduced acute care utilization among a high-risk group. Improvements in health-related quality of life were mixed and physical function outcomes did not differ between groups. Future studies are needed to determine whether more specific targeting will improve the program's effectiveness and whether reductions in acute care utilization will offset program costs. clinicaltrials.gov Identifier: NCT00182962.

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Author and article information

Contributors

Marcos Sepúlveda:

Computer Science DepartmentSchool of EngineeringPontificia Universidad Católica de ChileAv Vicuña Mackenna 4860MaculSantiago,Chile56 2 2534 4447marcos@ing.puc.cl

ORCID: http://orcid.org/0000-0002-9467-7666

Journal

Journal ID (nlm-ta): J Med Internet Res

Journal ID (iso-abbrev): J. Med. Internet Res

Journal ID (publisher-id): JMIR

Title: Journal of Medical Internet Research

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Print): 1439-4456

ISSN (Electronic): 1438-8871

Publication date Collection: April 2018

Publication date (Electronic): 10 April 2018

Volume: 20

Issue: 4

Electronic Location Identifier: e127

Affiliations

[1] ¹ Computer Science Department School of Engineering Pontificia Universidad Católica de Chile Santiago Chile

[2] ² Department of Internal Medicine School of Medicine Pontificia Universidad Católica de Chile Santiago Chile

[3] ³ Department of Family Medicine School of Medicine Pontificia Universidad Católica de Chile Santiago Chile

[4] ⁴ Institute of Information and Communication Technologies Universitat Politècnica de València Valencia Spain

Author notes

Corresponding Author: Marcos Sepúlveda marcos@ 123456ing.puc.cl

Author information

Tania Conca http://orcid.org/0000-0001-5959-3080

Cecilia Saint-Pierre http://orcid.org/0000-0002-3779-9990

Valeria Herskovic http://orcid.org/0000-0002-2650-6507

Marcos Sepúlveda http://orcid.org/0000-0002-9467-7666

Daniel Capurro http://orcid.org/0000-0002-9256-1256

Florencia Prieto http://orcid.org/0000-0003-0508-5229

Carlos Fernandez-Llatas http://orcid.org/0000-0002-2819-5597

Article

Publisher ID: v20i4e127

DOI: 10.2196/jmir.8884

PMC ID: 5915667

PubMed ID: 29636315

SO-VID: 4ee40f94-e340-470f-befe-9aa81514abd1

Copyright © ©Tania Conca, Cecilia Saint-Pierre, Valeria Herskovic, Marcos Sepúlveda, Daniel Capurro, Florencia Prieto, Carlos Fernandez-Llatas. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 10.04.2018.

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

History

Date received : 1 September 2017

Date revision requested : 28 September 2017

Date revision received : 31 January 2018

Date accepted : 18 February 2018

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